1889 Boston Medical and Surgical Journal  
The very considerable susceptibility of the foetus in utero to various diseases, infectious and otherwise, has been naturally most widely associated with conditions of the maternal organism, from the fact of the long-continued and intimate connection of the child with the mother as compared with that which it has with the father. The mother's power for infecting the foetus is, in other words, twofold ; namely, by a vitiated ovum, aud also post conceptum by influences operating through the
more » ... tal circulation ; while the father has but one such opportunity, namely, by a vitiated spermatozoon. In the case of one malady, syphilis, it is held by most authorities that the infection of the foetus may be conveyed solely by the father, the mother remaining uninfected unless by the syphilitic occupant of her uterus. Tuberculosis, if inherited, shows itself so much later than syphilis as greatly to complicate the problem of its transmission. A few instances in the human subject and in tho calf seem to show that the bacilli can traverse the placenta from the maternal organism, and though Cohnheim, with others, taught that tuberculosis was transmissible in the semen and in the ovum, it, must be confessed that the drift of recent opinion is against its being conveyed in the generativo element of either parent, or at least of the male. It is possible that in the study of foetal malaria we may find an aid to.the solution of some of these problems of pathological inheritance. For we have here a disease at once infectious and chronic, and like syphilis rather than tuberculosis, early in its manifestations after birth. The existence of foetal malaria has been sufficiently demonstrated by the observation of interuterine and neonatal chills, accompanied by an enlarged spleen, occurring in the child of a similarly affected mother. If she was infected at the time of conception, she was obviously infected throughout the pregnancy, so that the transmission of malaria per ovum could not be demonstrated, because such transmission per placentam could not be eliminated. So far as wo recall, no instances have hitherto been recorded where the child showing malaria, the father alone of the parents has had the disease. We, Mini, however, in the Edinburgh Medical Journal for June, two cases of great interest in this connection, recorded by Dr. R. W. Felkin, Lecturer on Diseases of the Tropics and Climatology, in the Edinburgh School of Medicine. In both, the father had wellmarked malaria, and the mother was free from it; yet the child showed symptoms of the infection. In the first case, the husband had contracted, on the west coast of Africa, both remittent and intermittent fever, on account of which he threw up his situation there, and went to the island of Madeira, where he met a Lancashire woman, and married her. They remained at Madeira eight months, and then went to Durban, Cape of Good Hope, the wife being eight months pregnant, and never having had any symptoms whatever of malaria. A week after her arrival Dr. Felkin saw her, complaining of a curious sensation in the abdomen, and he distinctly felt the foetus shaking. The lady said the same thing had happened on several previous occasions, though never so markedly before. The phenomenon occurred at tho same hour for four consecutive nights, when labor came on. Forceps were called for, and delivery was obstructed by the distended abdomen.of the child caused by enlarged spleen. After birth the child had seven attacks of ague, characterized by the cold, hot and sweating stages. The paroxysm lasted seven hours in all, and tho rectal temperature was 102°. The father stated that just before, and for the month following his marriage, he had had sevoral very severe attacks of ague. A possible objection to assigning the entire responsibility for this case to the father lies in the fact that, after removal to Durban, they were in a placo where malaria might be contracted, though of course, the exemption of the woman from all symptoms, and her short stay, would make her a very improbable medium for transmitting the infection to the child ; besides that she stated that similar though less extreme shakings of the foetus had been observed by her before. In the second case the child's parents had been married twelve years. The mother had never been away from Edinburgh. Three children had been born, all at full time, and quite healthy, during the first seven years after the parents' marriage. The father then went as fireman on a steamer trailing with West African ports. The men were forbidden to land at the ports, but the second engineer and this fireman managed to escape several times, aud had severe* remittent fever. The engineer died, and his death so frightened the fireman that ho did not go on shore again, although he remained another year in the service, suffering from ordinary ague. He had never suffered from syphilis. Ten months after his return homo a child was born at full time, but it soon " pined away and died." Rather more than a year
doi:10.1056/nejm188908291210909 fatcat:jeizgpikfvglxjt473gtfenlgy